Meibomian gland dysfunction is an eye condition that is also known as MGD, meibomianitis, meibomitis or lid margin disease. Our meibomian glands are located in our eyelids. These glands are responsible for releasing the lipid or oily layer of our tear film that are crucial in preventing rapid evaporation of our tears.
However, there are instances when the meibomian glands fail to produce or release the oil due to blockage in the glands or thickening of the meibum. This will affect the stability and the quality of the tear film and thereby produce dry eye symptoms even if the test results appear normal. A recent study by Lemp et al. Cornea 2012, revealed that 86% of their dry eye study cohort had meibomian gland dysfunction.
Meibomian gland dysfunction is a common eye condition, however, it often goes undetected or undiagnosed. Thus, most of the time, it is left untreated or treated ineffectively that it becomes chronic and severe.
Most of the time, persons suffering from dry eye conditions are treated as if their problem lies in the lack of tear production. They are then prescribed with eye drops that will replace tears in their eyes. On the contrary, however, majority of dry eye patients are suffering from meibomian gland dysfunction and tear replacement will not exactly solve the problem. Hence, proper diagnosis and detection are the keys to treating dry eye condition caused by meibomian gland dysfunction.
Here are some common procedures you may need to undergo to determine if your dry eye condition is brought about by meibomian gland dysfunction:
• Dry eye questionnaires to assess your eye’s condition.
• Meibomian Gland Evaluator. This is a hand-held instrument used by your eye doctor to evaluate your meibomian gland secretions during a routine eye examination. If liquid oil is found in the meibomian gland orifice during the assessment with the Meibomian Gland Evaluator, then this is indicative that the meibomian gland is not blocked or obstructed.
• Measure blink rate, lower tear meniscus height, tear osmolarity, tear break-up time and fluorescein staining techniques.
• LipiView Interferometer assesses in a quantitative manner the quality of the oil in a patient’s tear film. This in turn qualifies or disqualifies the patient from a LipiFlow treatment – see below.
• Schirmer’s and lower tear meniscus height to tell if an aqueous deficiency dry eye disease is present. If the dry eye symptoms and signs are present but the tear volume and the Schirmer’s test are normal, then you have evaporative dry eye disease.
• Assess the anatomy of the meibomian glands. This now can be done using novel infra red scanning instruments.
The treatment for meibomian gland dysfunction would depend on the specific symptoms of the condition. Here are some common treatments:
• Warm compress to liquefy secretions that have solidified and are blocking the meibomian glands. Warm compress may be applied on the eyelids one to two times a day, lasting for around four minutes each time. This may be followed by an eyelid massage. It is a particularly cumbersome process, which needs daily treatment ongoing for effective results.
• Eyelid scrubs.
• Oral antibiotics or anti-inflammatory drugs like doxycycline and steroid drops for two to four weeks.
• Omega-3 fatty acid supplements of 1,000mg to 2,000 mg per day. (Usually this equates to 3 – 6 capsules per day). Make sure you take these with food so they are absorbed more efficiently and it does not repeat on you.
• Topical antibiotic ointments.
• Proper eyelid hygiene. Makeup and eyeliner are significant contributors. Eyeliner should be placed on the outside of the eyelash margin not on the inside, where the meibomian glands can be blocked.
• Topical azithromycin which is anti-inflammatory and anti-microbial and with lipid-modulating properties. In Australia this needs to be compounded by a specialist pharmacist.
• LipiFlow Thermal Pulsation System. This is a 12-minute treatment that unblocks the meibomian glands by the application of controlled heat to the inner surfaces of lid margins while simultaneously applying pulsating pressure on the outer eyelids. This is the ultimate MGD and dry eye treatment. More on this exciting technology in a future post.
As you can see treating meibomian gland dysfunction is complex and needs to be done in a systematic way by an expert in dry eye management. Enquiries about your dry eyes can be made using the enquiry tab on the right or through the Contact Us tab.